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1.
Curr Urol Rep ; 22(8): 38, 2021 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-34086154

RESUMO

PURPOSE OF REVIEW: The purpose of this review paper is to describe the 24-h urine collection in terms of its utility, collection process, and common problems with its acquisition. RECENT FINDINGS: Although 24-h urine collections are standard of care for high-risk stone formers, several nuances in test acquisition including inaccurate urine collections 50% of the time and poor patient compliance limit its potential utility. Compliance in obtaining 24-h urine collections has been shown to be improved in patients who have not undergone surgical treatment of urinary calculi, patients with metabolic stone disease or family history of stone disease, Caucasian ethnicity, and in those with more sedentary occupations. Studies show conflicting data of compliance regarding patient age and gender. Physicians must understand the difficulties regarding 24-h urine collections including patient compliance, variability between collections, and complexities with interpretation to best utilize this tool in guiding clinical management for the treatment of nephrolithiasis.


Assuntos
Cooperação do Paciente , Coleta de Urina/métodos , Humanos , Valores de Referência , Fatores de Risco
2.
Zhongguo Yi Liao Qi Xie Za Zhi ; 45(3): 326-329, 2021 Jun 08.
Artigo em Chinês | MEDLINE | ID: mdl-34096246

RESUMO

Reference interval study and clinical evaluation are crucial supportive researches to demonstrate the intended use of quantitative in vitro diagnostic reagents. The process of determining reference interval, as well as the problems found frequently in clinical evaluation, are discussed here, and the links between them are analyzed from the aspects of product's traceability, intended use and group design. Further, some suggestions are offered in this paper.


Assuntos
Indicadores e Reagentes , Valores de Referência
3.
Zhongguo Yi Liao Qi Xie Za Zhi ; 45(3): 330-334, 2021 Jun 08.
Artigo em Chinês | MEDLINE | ID: mdl-34096247

RESUMO

The cut off value or reference interval is significant in clinical testing and diagnosis. If there is no scientific and reasonable cut off value or reference interval for in vitro diagnostic reagents, clinicians can not make medical decisions on patients through the results. The test will be meaningless, so the cut off value or reference interval study is an important part of the preclinical study of in vitro diagnostic reagents. In this article, combined to the review experience of related product, we discuss the establishment and verification of the cut off value and reference interval to provide a reference for relevant manufacturers.


Assuntos
Indicadores e Reagentes , Humanos , Valores de Referência
4.
Zhongguo Shi Yan Xue Ye Xue Za Zhi ; 29(3): 901-905, 2021 Jun.
Artigo em Chinês | MEDLINE | ID: mdl-34105491

RESUMO

OBJECTIVE: To explore the effects of hematocrit (HCT) on the parameters of thromboelastography (TEG) in healthy adults, so as to judge coagulation and fibrinolysis more accurately. METHODS: Three hundred and ninety-three healthy adults examined in Chengdu 363 Hospital Affiliated to Southwest Medical University from May 2018 to May 2019 were selected. HCT and TEG were detected at the same time. The differences of TEG parameters between the high HCT group and the low HCT group were compared. The correlation between HCT and TEG parameters was analyzed. The differences of TEG parameters between the healthy adults in Plateau and plain areas were compared. RESULTS: Among the parameters of TEG, R and K in high HCT group were significantly higher, and Angle, MA and CI were significantly lower than those in low HCT group, which showed statistically significance (P<0.05). There was no significant difference in LY30 and EPL between the two groups (P>0.05). R and K positively correlated with HCT (r=0.112, 0.517, P=0.027, 0.000), and Angle, MA and CI negatively correlated with HCT (r=-0.490, -0.408, -0.414, P=0.000). LY30 and EPL not correlated with HCT (P>0.05). HCT in plateau area was significantly higher than that in plain area (P<0.05). Among the parameters of TEG, K value was significantly higher, and Angle, MA and CI were significantly lower than those in plain area (P<0.05). R, LY30 and EPL were not significantly different from those in plain area (P>0.05). CONCLUSION: The difference of HCT may affect the values of R, K, Angle, MA and CI in TEG parameters. R and K positively correlate with HCT, while Angle, MA and CI negatively correlate with HCT. It is suggested that a suitable TEG reference range for the local population should be established, in plateau area especially K, Angle, MA and CI, which will be more conducive to the accurate evaluation of patients' coagulation and fibrinolysis status.


Assuntos
Coagulação Sanguínea , Tromboelastografia , Adulto , Hematócrito , Humanos , Valores de Referência
5.
Nat Commun ; 12(1): 3400, 2021 06 07.
Artigo em Inglês | MEDLINE | ID: mdl-34099648

RESUMO

Increased cerebrospinal fluid neurofilament light (NfL) is a recognized biomarker for neurodegeneration that can also be assessed in blood. Here, we investigate plasma NfL as a marker of neurodegeneration in 13 neurodegenerative disorders, Down syndrome, depression and cognitively unimpaired controls from two multicenter cohorts: King's College London (n = 805) and the Swedish BioFINDER study (n = 1,464). Plasma NfL was significantly increased in all cortical neurodegenerative disorders, amyotrophic lateral sclerosis and atypical parkinsonian disorders. We demonstrate that plasma NfL is clinically useful in identifying atypical parkinsonian disorders in patients with parkinsonism, dementia in individuals with Down syndrome, dementia among psychiatric disorders, and frontotemporal dementia in patients with cognitive impairment. Data-driven cut-offs highlighted the fundamental importance of age-related clinical cut-offs for disorders with a younger age of onset. Finally, plasma NfL performs best when applied to indicate no underlying neurodegeneration, with low false positives, in all age-related cut-offs.


Assuntos
Disfunção Cognitiva/diagnóstico , Depressão/diagnóstico , Síndrome de Down/diagnóstico , Doenças Neurodegenerativas/diagnóstico , Proteínas de Neurofilamentos/líquido cefalorraquidiano , Fatores Etários , Idoso , Biomarcadores/líquido cefalorraquidiano , Disfunção Cognitiva/líquido cefalorraquidiano , Estudos de Coortes , Depressão/líquido cefalorraquidiano , Síndrome de Down/líquido cefalorraquidiano , Reações Falso-Positivas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Neurodegenerativas/líquido cefalorraquidiano , Valor Preditivo dos Testes , Valores de Referência , Fatores Sexuais
6.
Nat Commun ; 12(1): 2965, 2021 05 20.
Artigo em Inglês | MEDLINE | ID: mdl-34017005

RESUMO

Single-cell RNA sequencing (scRNA-seq) has revealed an unprecedented degree of immune cell diversity. However, consistent definition of cell subtypes and cell states across studies and diseases remains a major challenge. Here we generate reference T cell atlases for cancer and viral infection by multi-study integration, and develop ProjecTILs, an algorithm for reference atlas projection. In contrast to other methods, ProjecTILs allows not only accurate embedding of new scRNA-seq data into a reference without altering its structure, but also characterizing previously unknown cell states that "deviate" from the reference. ProjecTILs accurately predicts the effects of cell perturbations and identifies gene programs that are altered in different conditions and tissues. A meta-analysis of tumor-infiltrating T cells from several cohorts reveals a strong conservation of T cell subtypes between human and mouse, providing a consistent basis to describe T cell heterogeneity across studies, diseases, and species.


Assuntos
Neoplasias/imunologia , RNA-Seq/métodos , Análise de Célula Única/métodos , Linfócitos T/imunologia , Viroses/imunologia , Animais , Diferenciação Celular/imunologia , Estudos de Coortes , Modelos Animais de Doenças , Regulação da Expressão Gênica/imunologia , Humanos , Linfócitos do Interstício Tumoral/imunologia , Camundongos , Neoplasias/sangue , Neoplasias/patologia , Valores de Referência , Software , Especificidade da Espécie , Subpopulações de Linfócitos T/imunologia , Microambiente Tumoral/imunologia , Viroses/sangue
7.
Lancet Haematol ; 8(6): e462-e466, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34048684

RESUMO

In haematology, as in all of medicine, the use of reference intervals for laboratory variables is essential to define disease states and inform treatment decisions. There are many haematological variables, including haemoglobin, mean corpuscular volume, absolute neutrophil count, and iron indices, that are often reported to be different on the basis of a person's race or ethnicity. Although there are many haematological conditions with a genetic basis, such that it is appropriate to consider ancestry in the diagnostic algorithm, defining pathology on the basis of a social construct such as race is unacceptable. The inclusion of separate thresholds or simple statements that so-called normal values vary by race further validates the common misperception that there are physiological differences between Black and white patients. These statements might have downstream effects on diagnostic and treatment decisions that exacerbate existing racial health disparities. In this Viewpoint, we argued for the removal of race-based reference intervals across haematology.


Assuntos
Testes Hematológicos/normas , Hemoglobinas/normas , Anemia Ferropriva/diagnóstico , Grupos Étnicos , Hemoglobinas/análise , Humanos , Laboratórios/normas , Valores de Referência
8.
Medicine (Baltimore) ; 100(18): e25812, 2021 May 07.
Artigo em Inglês | MEDLINE | ID: mdl-33950986

RESUMO

ABSTRACT: In this study, multiple-site, cross-sectional area (CSA) reference values were established for major peripheral nerves, including small branches, in the upper extremity of a healthy Asian population.This study included 107 prospectively recruited age-matched, healthy subjects with a mean age of 46 years (range, 24-75 years). All subjects underwent standardized nerve conduction studies for the median, ulnar, peroneal, posterior tibial, and sural nerves. CSA was measured unilaterally at 21 sites of the median, ulnar, radial, posterior interosseous, superficial radial sensory, musculocutaneous, lateral antebrachial cutaneous, and medial antebrachial cutaneous nerves.According to their age, the subjects were assigned to the younger group (20-40 years, n = 40), the middle group (40-59 years, n = 40), and the older group (60-80 years, n = 27). The significant differences of CSA values between age groups were found only at certain sites, such as the median (wrist, P = .003), ulnar (medial epicondyle, P = .031; forearm, P = .022), radial (antecubital fossa, P = .037), and superficial radial sensory nerve (P = .028). The CSA significantly correlated with gender, height, weight, and body mass index.This study provides CSA reference values for nerves, including small sensory nerves in the upper extremity, which can be useful in the ultrasonographic investigation of various peripheral neuropathies in the upper extremity.


Assuntos
Nervos Periféricos/anatomia & histologia , Doenças do Sistema Nervoso Periférico/diagnóstico , Extremidade Superior/inervação , Adulto , Fatores Etários , Anatomia Transversal , Grupo com Ancestrais do Continente Asiático , Feminino , Voluntários Saudáveis , Humanos , Masculino , Pessoa de Meia-Idade , Nervos Periféricos/diagnóstico por imagem , Estudos Prospectivos , Valores de Referência , Ultrassonografia , Adulto Jovem
9.
Undersea Hyperb Med ; 48(2): 119-126, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33975402

RESUMO

Exposure to a reduction in ambient pressure such as in high-altitude climbing, flying in aircrafts, and decompression from underwater diving results in circulating vascular gas bubbles (i.e., venous gas emboli [VGE]). Incidence and severity of VGE, in part, can objectively quantify decompression stress and risk of decompression sickness (DCS) which is typically mitigated by adherence to decompression schedules. However, dives conducted at altitude challenge recommendations for decompression schedules which are limited to exposures of 10,000 feet in the U.S. Navy Diving Manual (Rev. 7). Therefore, in an ancillary analysis within a larger study, we assessed the evolution of VGE for two hours post-dive using echocardiography following simulated altitude dives at 12,000 feet. Ten divers completed two dives to 66 fsw (equivalent to 110 fsw at sea level by the Cross correction method) for 30 minutes in a hyperbaric chamber. All dives were completed following a 60-minute exposure at 12,000 feet. Following the dive, the chamber was decompressed back to altitude for two hours. Echocardiograph measurements were performed every 20 minutes post-dive. Bubbles were counted and graded using the Germonpré and Eftedal and Brubakk method, respectively. No diver presented with symptoms of DCS following the dive or two hours post-dive at altitude. Despite inter- and intra-diver variability of VGE grade following the dives, the majority (11/20 dives) presented a peak VGE Grade 0, three VGE Grade 1, one VGE Grade 2, four VGE Grade 3, and one VGE Grade 4. Using the Cross correction method for a 66-fsw dive at 12,000 feet of altitude resulted in a relatively low decompression stress and no cases of DCS.


Assuntos
Altitude , Mergulho/fisiologia , Embolia Aérea/diagnóstico por imagem , Adulto , Pressão Atmosférica , Exercícios Respiratórios , Descompressão/métodos , Descompressão/estatística & dados numéricos , Doença da Descompressão/etiologia , Doença da Descompressão/prevenção & controle , Ecocardiografia , Embolia Aérea/etiologia , Humanos , Masculino , Valores de Referência , Água do Mar , Treinamento por Simulação , Fatores de Tempo
10.
Undersea Hyperb Med ; 48(2): 127-147, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33975403

RESUMO

Multiday hyperbaric exposure has been shown to reduce the incidence of decompression sickness (DCS) of compressed-air workers. This effect, termed acclimatization, has been addressed in a number of studies, but no comprehensive review has been published. This systematic review reports the findings of a literature search. PubMed, Ovid Embase, The Cochrane Library and Rubicon Research Repository were searched for studies reporting DCS incidence, venous gas embolism (VGE) or subjective health reports after multiday hyperbaric exposure in man and experimental animals. Twenty-nine studies fulfilled inclusion criteria. Three epidemiological studies reported statistically significant acclimatization to DCS in compressed-air workers after multiday hyperbaric exposure. One experimental study observed less itching after standardized simulated dives. Two human experimental studies reported lower DCS incidence after multiday immersed diving. Acclimatization to DCS has been observed in six animal species. Multiday diving had less consistent effect on VGE after hyperbaric exposure in man. Four studies observed acclimatization while no statistically significant acclimatization was reported in the remaining eight studies. A questionnaire study did not report any change in self-perceived health after multiday diving. This systematic review has not identified any study suggesting a sensitizing effect of multiday diving, and there is a lack of data supporting benefit of a day off diving after a certain number of consecutive diving days. The results suggest that multiday hyperbaric exposure probably will have an acclimatizing effect and protects from DCS. The mechanisms causing acclimatization, extent of protection and optimal procedure for acclimatization has been insufficiently investigated.


Assuntos
Aclimatação/fisiologia , Doença da Descompressão/prevenção & controle , Mergulho/fisiologia , Embolia Aérea/prevenção & controle , Oxigenação Hiperbárica , Doenças Profissionais/prevenção & controle , Animais , Pressão Atmosférica , Gatos , Doença da Descompressão/epidemiologia , Autoavaliação Diagnóstica , Mergulho/efeitos adversos , Mergulho/estatística & dados numéricos , Cães , Embolia Aérea/epidemiologia , Cabras , Humanos , Incidência , Doenças Profissionais/epidemiologia , Coelhos , Ratos , Ratos Sprague-Dawley , Valores de Referência , Ovinos , Fatores de Tempo
11.
Undersea Hyperb Med ; 48(2): 153-156, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33975405

RESUMO

Hydrogen sulfide (H2S) is a toxic gas produced via breakdown of organic matter. Hydrogen sulfide exposure can cause symptoms ranging in severity from mild effects (dizziness, headache, nausea) to severe lactic acidosis, respiratory failure, pulmonary edema, cardiac arrhythmias and death. Treatment modalities include oral countermeasures and 100% FiO2 with supportive therapy. However, case studies utilizing hyperbaric oxygen (HBO2) therapy have been reported with general benefit seen in severe cases of toxicity. In this report, cases of mild to moderate H2S toxicity occurred aboard a U.S. Navy ship, resulting in a mass casualty incident of more than 30 patients. Patient symptoms included dizziness, headaches, nausea, vomiting, and one patient with altered mental status. Most patients' symptoms resolved after several hours of supportive therapy, but six patients had symptoms refractory to 100% FiO2 at 1 atm. These six patients received HBO2 therapy with a USN Treatment Table 9 after consultation with the local emergency room and hyperbaric assets. Four separate chambers were utilized, including two chambers onboard USN ships and the local explosive ordnance disposal (EOD) chamber. Complete resolution of symptoms in all six patients was achieved within the first breathing period. Patients were monitored after treatment aboard the USN ship medical department. No patients required emergency department care. These cases demonstrate an expanded use of HBO2 to include moderate cases of H2S toxicity refractory to first-line therapy.


Assuntos
Poluentes Ocupacionais do Ar/envenenamento , Sulfeto de Hidrogênio/envenenamento , Oxigenação Hiperbárica/métodos , Incidentes com Feridos em Massa , Militares , Navios , Poluentes Ocupacionais do Ar/análise , Serviços Médicos de Emergência , Feminino , Humanos , Sulfeto de Hidrogênio/análise , Masculino , Envenenamento/terapia , Valores de Referência , Avaliação de Sintomas , Estados Unidos
12.
Undersea Hyperb Med ; 48(2): 157-168, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33975406

RESUMO

Introduction: Safe administration of critical care hyperbaric medicine requires specialized equipment and advanced training. Equipment must be tested in order to evaluate function in the hyperbaric environment. High-frequency percussive ventilation (HFPV) has been used in intensive care settings effectively, but it has never been tested in a hyperbaric chamber. Methods: Following a modified U.S. Navy testing protocol used to evaluate hyperbaric ventilators, we evaluated an HFPV transport ventilator in a multiplace hyperbaric chamber at 1.0, 1.9, and 2.8 atmospheres absolute (ATA). We used a test lung with analytical software for data collection. The ventilator uses simultaneous cyclic pressure-controlled ventilation at a pulsatile flow rate (PFR)/oscillatory continuous positive airway pressure (oCPAP) ratio of 30/10 with a high-frequency oscillation percussive rate of 500 beats per minute. Inspiratory and expiratory times were maintained at two seconds throughout each breathing cycle. Results: During manned studies, the PFR/oCPAP ratios were 26/6, 22/7, and 22.5/8 at an airway resistance of 20cm H2O/L/second and 18/9, 15.2/8.5, and 13.6/7 at an airway resistance of 50 cm/H2O/L/second at 1, 1.9, and 2.8 ATA. The resulting release volumes were 800, 547, and 513 mL at airway resistance of 20 cm H2O/L/sec and 400, 253, and 180 mL at airway resistance of 50 cm/H2O/L/sec at 1, 1.9, and 2.8 ATA. Unmanned testing showed similar changes. The mean airway pressure (MAP) remained stable throughout all test conditions; theoretically, supporting adequate lung recruitment and gas exchange. A case where HFPV was used to treat a patient for CO poisoning was presented to illustrate that HFPV worked well under HBO2 conditions and no complications occurred during HBO2 treatment. Conclusion: The HFPV transport ventilator performed adequately under hyperbaric conditions and should be considered a viable option for hyperbaric critical care. This ventilator has atypical terminology and produces unique pulmonary physiology, thus requiring specialized training prior to use.


Assuntos
Ventilação de Alta Frequência/instrumentação , Oxigenação Hiperbárica/instrumentação , Lesão por Inalação de Fumaça/terapia , Ventiladores Mecânicos , Acidose/etiologia , Idoso , Resistência das Vias Respiratórias , Pressão Atmosférica , Intoxicação por Monóxido de Carbono/complicações , Feminino , Ventilação de Alta Frequência/métodos , Humanos , Oxigenação Hiperbárica/métodos , Pulmão/fisiologia , Respiração com Pressão Positiva/instrumentação , Respiração com Pressão Positiva/métodos , Troca Gasosa Pulmonar/fisiologia , Fluxo Pulsátil , Valores de Referência , Respiração
13.
BMC Pediatr ; 21(1): 241, 2021 05 19.
Artigo em Inglês | MEDLINE | ID: mdl-34011305

RESUMO

OBJECTIVE: To establish reference intervals for hemoglobin and mean corpuscular volume (MCV) in an ethnically diverse community sample of Canadian children 36 months and younger. METHODS: We collected blood samples from young children at scheduled primary care health supervision visits at 2 weeks, 2, 4, 6, 9, 12, 15, 18, 24, and 36 months of age. Samples were analyzed on the Sysmex XN-9000 Hematology Analyzer. We followed the Clinical and Laboratory Standards Institute guidelines in our analysis. Data were partitioned by sex and also combined. We considered large age partitions (3 and 6 months) as well as monthly partitions. Reference intervals (lower and upper limits) and 90% confidence intervals were calculated. RESULTS: Data from 2106 children were included. The age range was 2 weeks to 36 months, 46% were female, 48% were European and 23% were of mixed ethnicity. For hemoglobin, from 2 to 36 months of age, we found a wide reference interval and the 90% confidence intervals indicated little difference across age groups or according to sex. For MCV, from 2 to 7 months of age there was considerable decrease in the reference interval, which was lowest during the second year of life, followed by a slight increase in the last months of the third year of life. CONCLUSION: These findings suggest adoption of a single hemoglobin reference interval for children 2-36 months of age. Further studies in children under 4 months of age are needed. TRIAL REGISTRATION: TARGet Kids! cohort is registered at ClinicalTrials.gov. www.clinicaltrials.gov . Identifier: NCT01869530 .


Assuntos
Índices de Eritrócitos , Hemoglobinas , Canadá , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Padrões de Referência , Valores de Referência
14.
BMJ Open ; 11(5): e049143, 2021 05 07.
Artigo em Inglês | MEDLINE | ID: mdl-33963059

RESUMO

OBJECTIVES: It is essential to have simple, reliable and valid tests to measure children's functional capacity in schools or medical practice. The 1-minute sit-to-stand (STS) test is a quick fitness test requiring little equipment or space that is increasingly used in both healthy populations and those with chronic disease. We aimed to provide age-specific and sex-specific reference values of STS test in healthy children and adolescents and to evaluate its short-term reliability and construct validity. DESIGN SETTING AND PARTICIPANTS: Cross-sectional convenience sample from six public schools and one science fair in central Europe. Overall, 587 healthy participants aged 5-16 years were recruited and divided into age groups of 3 years each. OUTCOMES: 1-minute STS. To evaluate short-term reliability, some children performed the STS test twice. To evaluate construct validity, some children also performed a standing long jump (SLJ) and a maximal incremental exercise test. RESULTS: Data from 547 youth aged 5-16 years were finally included in the analyses. The median number of repetitions in 1 min in males (females) ranged from 55 [95% CI: 38 to 72] (53 [95% CI: 35 to 76]) in 14-16-year olds to 59 [95% CI: 41 to 77] (60 [95% CI: 38 to 77]) in 8-10-year olds. Children who repeated STS showed a learning effect of on average 4.8 repetitions more than the first test (95% limits of agreement: -6.7 to 16.4). Moderate correlations were observed between the STS and the SLJ (r=0.48) tests and the maximal exercise test (r=0.43). CONCLUSIONS: The reported STS reference values can be used to interpret STS test performance in children and adolescents. The STS appears to have good test-retest reliability, but a learning effect of about 10%. The association of STS with other measures of physical fitness should be further explored in a larger study and technical standards for its conduct are needed.


Assuntos
Teste de Esforço , Adolescente , Criança , Pré-Escolar , Estudos Transversais , Europa (Continente) , Feminino , Humanos , Masculino , Valores de Referência , Reprodutibilidade dos Testes
15.
Nat Commun ; 12(1): 3199, 2021 05 27.
Artigo em Inglês | MEDLINE | ID: mdl-34045463

RESUMO

In patients with metastatic cancer, spatial heterogeneity of somatic alterations may lead to incomplete assessment of a cancer's mutational profile when analyzing a single tumor biopsy. In this study, we perform sequencing of cell-free DNA (cfDNA) and distinct metastatic tissue samples from ten rapid autopsy cases with pre-treated metastatic cancer. We show that levels of heterogeneity in genetic biomarkers vary between patients but that gene expression signatures representative of the tumor microenvironment are more consistent. Across nine patients with plasma samples available, we are able to detect 62/62 truncal and 47/121 non-truncal point mutations in cfDNA. We observe that mutation clonality in cfDNA is correlated with the number of metastatic lesions in which the mutation is detected and use this result to derive a clonality threshold to classify truncal and non-truncal driver alterations with reasonable specificity. In contrast, mutation truncality is more often incorrectly assigned when studying single tissue samples. Our results demonstrate the utility of a single cfDNA sample relative to that of single tissue samples when treating patients with metastatic cancer.


Assuntos
Autopsia/métodos , DNA Tumoral Circulante/genética , Análise Mutacional de DNA/métodos , Neoplasias/diagnóstico , Microambiente Tumoral/genética , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Biomarcadores Tumorais/genética , Quimiorradioterapia Adjuvante , Estudos de Coortes , Variações do Número de Cópias de DNA , Feminino , Heterogeneidade Genética , Humanos , Masculino , Terapia Neoadjuvante , Neoplasias/sangue , Neoplasias/patologia , Neoplasias/terapia , Mutação Puntual , RNA-Seq , Valores de Referência , Sensibilidade e Especificidade , Análise Espacial , Fatores de Tempo , Sequenciamento Completo do Exoma
16.
Medicine (Baltimore) ; 100(21): e25947, 2021 May 28.
Artigo em Inglês | MEDLINE | ID: mdl-34032704

RESUMO

ABSTRACT: To compare the speed of propagation of ultrasound (US) waves (SoS) of the lower leg with the clinical reference standard computed tomography (CT) at the level of lumbar vertebra 3 (L3) for muscle loss assessment. Both calf muscles of 50 patients scheduled for an abdominal CT were prospectively examined with ultrasound. A plexiglas-reflector located on the opposite side of the probe with the calf in between was used as a timing reference for SoS (m/s). CT measurements were performed at the level of L3 and included area (cm2) and attenuation (HU) of the psoas muscle, abdominal muscles, subcutaneous fat, visceral fat and abdominal area. Correlations between SoS, body mass index (BMI) and CT were determined using Pearson's correlation coefficient. Based on reported CT sarcopenia threshold values, receiver operating characteristic (ROC) analysis was performed for SoS. Inter-examiner agreement was assessed with the median difference, inter-quartile range (IQR) and intraclass correlation coefficients. SoS of the calf correlated moderately with abdominal muscle attenuation (r = 0.48; P < .001), psoas muscle attenuation (r = 0.40; P < .01), abdominal area (r = -0.44; P < .01) and weakly with subcutaneous fat area (r = -0.37; P < .01). BMI correlated weakly with psoas attenuation (r = -0.28; P < .05) and non-significantly with abdominal muscle attenuation. Normalization with abdominal area resulted in moderate correlations with abdominal muscle area for SoS (r = 0.43; P < .01) and BMI (r = -0.46; P < .001). Based on sarcopenia threshold values for skeletal muscle attenuation (SMRA), area under curve (AUC) for SoS was 0.724. Median difference between both examiners was -3.4 m/s with IQR = 15.1 m/s and intraclass correlation coefficient = 0.794. SoS measurements of the calf are moderately accurate based on CT sarcopenia threshold values, thus showing potential for muscle loss quantification.


Assuntos
Perna (Membro)/diagnóstico por imagem , Músculo Esquelético/diagnóstico por imagem , Sarcopenia/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Índice de Massa Corporal , Feminino , Humanos , Gordura Intra-Abdominal/diagnóstico por imagem , Gordura Intra-Abdominal/fisiopatologia , Perna (Membro)/fisiopatologia , Vértebras Lombares , Masculino , Pessoa de Meia-Idade , Músculo Esquelético/fisiopatologia , Estudos Prospectivos , Curva ROC , Valores de Referência , Sarcopenia/fisiopatologia , Gordura Subcutânea/diagnóstico por imagem , Gordura Subcutânea/fisiopatologia , Fatores de Tempo , Tomografia Computadorizada por Raios X , Ultrassonografia
17.
Medicine (Baltimore) ; 100(21): e26080, 2021 May 28.
Artigo em Inglês | MEDLINE | ID: mdl-34032741

RESUMO

ABSTRACT: To determine optimal gestational weight gain (GWG) for the Chinese population.Live singleton deliveries at the largest maternal & childcare hospital in northwest China from 2010 to 2012 were analyzed retrospectively. Multivariable logistic regression analysis was conducted to determine the lowest aggregated risk of interested perinatal outcomes based on Chinese adult body mass index (BMI) categories.Eight thousand eight hundred seventy enrolled parturients were divided into 4 groups according to their prepregnancy BMI: underweight (21.31%, BMI < 18.5 kg/m2), normal weight (67.81%, 18.5 kg/m2 ≤ BMI < 24 kg/m2), overweight (8.99%, 24 kg/m2 ≤ BMI < 28 kg/m2 and obese (1.89%, BMI ≥ 28 kg/m2). The optimal GWG values for the above 4 groups were 16.7 kg (GWG range, 12.0-21.5), 14.5 kg (9.5-19.5), 11.5 kg (7.0-16.5), and 8.0 kg (5.0-13.0). The rates of inadequate, optimal and excessive GWG in present study were 6.14% (545), 62.34% (5529), and 31.52% (2796) respectively, which were significantly different from those of the 2009 Institute of Medicine recommendation (χ2 = 1416.05, Pinteraction < 0.0001).Wider optimal GWG ranges than those recommended by Institute of Medicine were found in our study, and our proposed criteria seems to be practical to the Chinese population.


Assuntos
Índice de Massa Corporal , Ganho de Peso na Gestação , Sobrepeso/diagnóstico , Magreza/diagnóstico , Adulto , China/epidemiologia , Feminino , Humanos , Recém-Nascido Pequeno para a Idade Gestacional , Idade Materna , Sobrepeso/epidemiologia , Gravidez , Resultado da Gravidez , Valores de Referência , Estudos Retrospectivos , Magreza/epidemiologia , Adulto Jovem
18.
Medicine (Baltimore) ; 100(21): e26147, 2021 May 28.
Artigo em Inglês | MEDLINE | ID: mdl-34032768

RESUMO

INTRODUCTION: Acyclovir (ACV)-associated encephalopathy is related to an increase in plasma levels of 9-carboxymethoxymethylguanine, an ACV metabolite, and is often reported in patients with renal dysfunction. We report a case of ACV-associated encephalopathy with rapid progression of renal dysfunction after oral administration of valacyclovir (VACV) and review literature of previous ACV-associated encephalopathy cases. PATIENT CONCERNS: An 88-year-old man was diagnosed with herpes zoster. VACV (3000 mg/day) treatment was initiated. Serum creatinine (Cr) level was 0.80 mg/dL. However, irritability, memory impairment, and decreased responsiveness occurred after 3 days. The Cr level was 6.76 mg/dL on admission. DIAGNOSIS: He was diagnosed with ACV-associated encephalopathy with acute kidney injury. INTERVENTIONS: VACV was discontinued, hemodialysis was initiated on the day of admission, and then the signs and symptoms improved approximately 72 hours after the admission. CONCLUSION: Worsening of renal function and encephalopathy should be a focus when using VACV or ACV, regardless of age and original renal function. Acute kidney injury and ACV-associated encephalopathy may particularly occur in the elderly even when renal function is normal. Therefore, regular monitoring of renal function and consciousness is necessary during VACV treatment.


Assuntos
Injúria Renal Aguda/induzido quimicamente , Antivirais/efeitos adversos , Encefalopatias/induzido quimicamente , Herpes Zoster/tratamento farmacológico , Valaciclovir/efeitos adversos , Injúria Renal Aguda/terapia , Idoso de 80 Anos ou mais , Creatinina/sangue , Guanina/análogos & derivados , Guanina/sangue , Herpes Zoster/sangue , Herpes Zoster/fisiopatologia , Humanos , Rim/fisiologia , Masculino , Valores de Referência , Diálise Renal
19.
J Clin Neurosci ; 88: 16-21, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33992178

RESUMO

BACKGROUND: There are no established ranges for metabolic values prior to death by neurologic criteria/brain death determination (DNC/BD) and the thresholds required by institutional protocols and accepted by neurointensivists is unknown. METHODS: We designed a survey that addressed 1) the metabolic tests required in institutional guidelines prior to brain death determination, 2) the metabolic tests the respondent reviewed prior to brain death determination, and 3) the metabolic test thresholds for laboratory tests that were perceived to preclude or permit clinical DNC/BD determination. The survey was distributed online to physicians in the Neurocritical Care Society from September to December 2019. Respondents were dichotomized based on the number of brain death evaluations they had performed (≤20 vs. > 20) and responses were compared between groups. RESULTS: The survey was completed by 84 physicians. Nearly half (47.6%) of respondents did not believe their institutions required metabolic testing. The metabolic testing for which institutions most commonly provided a defined threshold were arterial pH (34.5%, 29/84), sodium (28.6%, 24/84), and glucose (15.5%, 13/84). Nearly all (97.6%) respondents routinely reviewed metabolic tests prior to brain death evaluation, the most common of which were: sodium (91.7%, 77/84), arterial pH (83.3%, 70/84), and glucose (79.8%, 67/84). Respondents who had performed > 20 evaluations were less likely to check thyroxine and total bilirubin (3.6%, 2/55 vs. 20.7%, 6/29 (p = 0.011) and 12.7%, 7/55 vs. 31%, 9/29 (p = 0.042), respectively), and had a more liberal upper limit of potassium (6.3 mEq/L vs 6.0 mEq/L, p = 0.045). CONCLUSION: Prior to brain death evaluation, neurocritical care providers commonly review similar metabolic tests and have similar thresholds regarding values that would preclude clinical brain death determination. This finding is independent of experience with brain death determination.


Assuntos
Morte Encefálica/sangue , Morte Encefálica/diagnóstico , Cuidados Críticos/normas , Guias como Assunto , Adulto , Idoso , Análise Química do Sangue , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Médicos , Valores de Referência , Inquéritos e Questionários
20.
Zhonghua Yi Xue Za Zhi ; 101(19): 1410-1414, 2021 May 25.
Artigo em Chinês | MEDLINE | ID: mdl-34034369

RESUMO

Objective: To analyze the distribution and variance of neonatal pulse oxygen saturation (SpO2) at different altitudes in China, and provide a new evidence for the screening of NCHD at high altitudes. Methods: Based on the database of National Screening Project of NCHD, the distribution of SpO2 values was described in 26 766 newborns at altitudes of 0-100 m, 600-700 m, 900-1 100 m, 1 400-1 600 m, 1 900-2 100 m, and 2 200-2 500 m. One-way analysis of variance was used to analyze the differences among SpO2 values in newborns at different altitudes. Results: The average SpO2 values of right hand in newborns at altitudes of 0-100 m, 600-700 m, 900-1 100 m, 1 400-1 600 m, 1 900-2 100 m and 2 200-2 500 m were 97.7%±1.4%, 97.1%±1.1%, 96.1%±1.3%, 96.0%±1.7%, 95.9%±1.7% and 95.5%±2.4%, respectively. And corresponding average SpO2 values of either foot were 97.7%±1.4%, 96.9%±1.1%, 96.3%±1.4%, 96.0%±1.7%, 95.6%±1.8% and 95.2%±2.7%, respectively. There were statistically significant differences in the average SpO2 values of newborns at different altitudes (right hand: F=1 248.35, P<0.001; either foot: F=1 280.45, P<0.001). The SpO2 of newborns tended to be lower with the increase of altitudes (P-trend<0.001). Conclusion: SpO2 values in newborns were negatively associated with the altitudes, which indicated that the cut-off value of screening for NCHD at sea level might not be applicable to newborns at higher altitudes. Thus, it is worthwhile to conducted studies on the normal values of SpO2 and the cut-off value of screening for NCHD in newborns at high altitudes.


Assuntos
Altitude , Oximetria , China , Humanos , Recém-Nascido , Oxigênio , Valores de Referência
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